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Letter from Medical Board to NV Legislators, May 2008 Letter from Governor Gibbons to Medical Board, May 2008
May 23, 2008
Honorable Sheila Leslie Chairwoman, Legislative Committee on Health Care Honorable Steven A. Horsford Member, Legislative Committee on Health Care
Dear
Chairwoman Leslie and Senator Horsford: In as much as Dr. Javaid Anwar, M.D., the
President of the Nevada State Board of Medical Examiners, has
recused himself from any consideration or actions in the Endoscopy
Center of Southern Nevada case, your letter dated May 12, 2008, has
been referred to me, as Acting Chair on these matters, for response. First and foremost, please let me assure you
that all members of the Nevada State Board of Medical Examiners (the
“Board”), its Executive Director, and its staff share your concern
over the very serious crisis that has arisen from practices at the
Endoscopy Center of Southern Nevada. Your accusations as to the competency of the
Board’s Executive Director, while I am sure are well-intentioned,
are based upon inaccurate information.
As you correctly pointed out in your
letter, on February 27, 2008, the Southern Nevada Health District
informed the public of its findings resulting from procedures
performed at the Endoscopy Center of Southern Nevada.
The newspaper report of this
release (on February 28, 2008) was the first time the Board and its
staff became aware of this crisis.
The Bureau of Licensure and Certification, the
Upon learning of the crisis, the Board’s
Executive Director immediately instructed the Chief of the Board’s
Investigative Division to begin a full investigation.
Specifically, the Chief of the Investigative Division was
told to immediately: (i)
open files on all of the reported cases of Hepatitis C; (ii) issue
subpoenas for medical records from the Endoscopy Center of Southern
Nevada for all patients infected (the “Board subpoenas”); (iii)
obtain lists of all patients treated on the days of the suspected
transmission; and (iv) obtain the names and addresses of all
employees and owners of the Endoscopy Center of Southern Nevada.
The Board subpoenas were issued that same day (February 28,
2008) and were sent to Thereafter, on March 10, 2008, while the
Endoscopy Center’s attorneys and employees were working on the
response to the Board subpoenas, local law enforcement confiscated
all of the Endoscopy Center’s records in connection with its own
investigation of possible criminal charges, thereby preventing the
Board from obtaining the evidence necessary to initiate action
against the medical licenses of the involved physicians. The allegation that the Executive Director
refused to comply with a Grand Jury subpoena in order to protect
physicians is simply false.
When a Clark County Deputy District Attorney publicly accused
the Board of not cooperating with the Grand Jury subpoena, he failed
to disclose that the date for compliance with the subpoena had not
yet arrived. At that
very time, the Nevada Attorney General’s office was assisting the
Board’s Investigative Division in preparation of an appropriate
confidentiality agreement with the Las Vegas Metropolitan Police
Department so that the Board could fulfill its statutory obligations
under to NRS 630.336(4) and to keep confidential some sensitive
information, including, but not limited to, the names of patients
and complainants. As
you may be aware, such an agreement was timely reached, and law
enforcement has already reviewed all files and records sought by the
Grand Jury subpoena.
Further, it has received copies of all documents it requested from
the Board. From the inception of the Board’s involvement in
this tragic matter, its investigators have been participants in the
law enforcement task force and have attended each of its weekly
meetings. The Board’s
investigators and other participating law enforcement agencies have
exchanged evidence and other information in a cooperative spirit.
Both the Board and its
staff have, and will continue to, work diligently to uphold our
statutory responsibilities in protecting the citizens of The Bureau of Licensure
and Certification began its investigation of the I am confident that the Board’s Executive
Director did not mislead the public or your Committee regarding the
Board’s authority to immediately suspend licenses of physicians
employed at the
The Board, through its
Executive Director and its staff, has pursued the investigation in
this matter with the utmost urgency, integrity and professionalism,
and will continue to do so.
The Board’s Executive Director has vast experience and knows
the law well. Further,
he diligently discusses and obtains input from Board officers and
from the Nevada Attorney General’s office prior to taking any action
on behalf of the Board. In attempting to determine what remedies are
available to the Board, its Executive Director and the Board
President, before the President's recusal, were in constant
communication with the Nevada Attorney General’s office as well as
the Board's legal staff.
With respect to the Board taking any action to summarily
suspend the licenses of those physicians who were allegedly involved
in the Hepatitis C outbreak, we could not legally
pursue emergency summary license suspensions since the dangerous and
improper conduct had been corrected and the Endoscopy Center (and
affiliated Centers) had been closed due to the loss of its business
license. All of the
foregoing has been discussed with me as the acting Board chair
regarding this investigation.
As you are aware, any action by the Board pursuant to NRS
233B.127 requires that it make a finding that public health, safety
or welfare imperatively require immediate emergency action.
As I am sure you can now appreciate, the Board simply did not
have sufficient evidence to support such a finding, and since the
report of the Health District of Southern Nevada stated that the
cause of the transmission came from the administration of anesthesia
by CRNAs, there was not specific evidence to prove improper medical
conduct against any doctor.
Consequently, based on these facts, the Nevada Attorney
General's Office agreed there was not sufficient legal ground to
pursue summary suspension under NRS 233B.127.
Thus, the Board’s Executive Director correctly advised the
Legislative Committee on Health Care (on April 21, 2008) that the
Board did not have the authority to pursue summary suspensions.
The Board has and continues to engage in an
aggressive investigation into this matter and is obtaining evidence
to support its legal ability to take disciplinary action against any
and all of the physicians who may have been involved in the tragic
outbreak of Hepatitis C, despite our efforts being hindered by law
enforcement’s understandable seizure of all medical records and
other evidence from the Endoscopy Center.
Please note that the Board effectuated the
voluntary agreement for one of the principal owners of the Endoscopy
Center to cease the practice of medicine in a relatively short
period of time after learning of the crisis and has actively pursued
injunctive relief against certain of its licensees (pursuant to NRS
630.388) by working through the Nevada Attorney General’s Office;
which, as you know, has resulted in two physicians being enjoined
from the practice of medicine in Nevada by the Eighth Judicial
District Court. Finally, as a point of
fact, the Board is the only health licensing agency that has
actually filed a disciplinary complaint against an involved
licensee. The six
Certified Registered Nurse Anesthetists voluntarily surrendered
their licenses during the pendency of the investigation into the
outbreak, but no disciplinary action has been filed against any of
them, or against any of the other nurse licensees who worked at the As I hope you can
appreciate, the Board cannot respond in this letter to all the media
reports; some of which are true, some of which have been taken out
of context, and some of which are factually incorrect.
Neither the Board nor its staff has ever interfered with or
otherwise delayed any law enforcement investigation of this matter.
Currently, it is my understanding that law enforcement has
not even started its review of the evidence it confiscated from the
Endoscopy Centers on March 10, 2008.
The Board continues to
uphold its mandate to ensure the safety of the public in all that it
does. Please rest
assured, however, that the Board’s vigorous investigation into this
matter, while fully cooperating with law enforcement, remains its
number one priority. Sincerely, Secretary-Treasurer |
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May 29, 2008
Javaid Anwar, M.D. President
On April 2, 2008 three temporary members were
appointed to the State Board of Medical Examiners (“Board”) to
replace Board members who had conflicts of interest with Dr. Dipak
Desai or with the Endoscopy Center of Southern Nevada. These
temporary members were appointed so that a full, non-conflicted,
nine-member Board would be available to investigate the critical
issue of public health and safety relating to the Hepatitis C
infections originating out of
It is our understanding that as of this time neither you nor Board staff has even contacted the three temporary members. The Hepatitis C infection from the Endoscopy Center of Southern Nevada is a health care crisis. Public confidence in the health care system has been eroded. Nevadans must know that the State is taking swift and decisive action to protect the health and safety of its citizens. The fact that the Board has not even held a hearing to inform the public and its temporary members of the Board’s plan to investigate physicians involved in this matter is simply inexcusable.
At this point, we see no alternative but to
demand an immediate and detailed report of all actions the Board has
taken to date to address the role any
We also request that the Board assign appropriate and qualified Board staff members to oversee the pertinent proceedings. The Executive Director of the Board has demonstrated an unwillingness to vigorously handle the matter.
It is essential that the Board and Board staff promptly conduct the work they are charged with to ensure public safety and to restore the public’s faith in our healthcare system. It is clear in state law that the Board’s ultimate responsibility is to ensure the safety of the public. We expect that the Board will follow through on this charge without further delay. Please remember that NRS 630.003 grants authority to the Board of Medical Examiners and charges them to always consider the protection and benefit of the public.
We realize you have recused yourself from matters
concerning the
We look forward to hearing from you and your staff.
Sincerely, JIM GIBBONS Governor SENATOR RANDOLPH TOWNSEND Chairman, Senate Commerce and Labor
SENATOR JOSEPH HECK, D.O. Clark District 5
SENATOR STEVEN HORSFORD Clark District 4
ASSEMBLYWOMAN SHEILA LESLIE Washoe District 27
CC: Drennan A. Clark, J.D., Executive Director
Charles N. Held, M.D., Board Member Cindy Lamerson, M.D., Board Member S. Daniel McBride, M.D., Board Member Benjamin J. Rodriguez, M.D., Board Member Jean Stoess, M.A., Board Member Renee West, Board Member Ronald Kline, M.D., Temporary Board Member Beverly Neyland, M.D., Temporary Board Member Robert Wiencek, Jr., M.D., Temporary Board Member Senator William Raggio Speaker Barbara Buckley Assemblywoman Heidi Gansert Catherine Cortez Masto, Attorney General |
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Page created by Susan E. Gallagher, Associate Professor, Political Dept., UMass Lowell, 5/08 |
Page under construction, 3/08